Medical imaging of malignant external otitis in the presence of squamous cell carcinoma (original) (raw)
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The Scientific World Journal, 2014
Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.
European Archives of Oto-Rhino-Laryngology, 2007
Computerized tomography (CT) scanning is a well recognised tool for the diagnosis of malignant external otitis. To investigate the degree of correlation between CT Wndings scan and the patients clinical status focusing on a subgroup of patients with cranial nerve palsies. Diagnosis of malignant external otitis was conWrmed in 23 patients (average age 71 years, age range 39-87) based on criteria of severe pain, otitis externa refractory to conventional treatments and possibly diabetes mellitus and pseudomonas detection. CT was performed on 23 of these patients. Results from these scans were analysed and correlated with patient clinical status. Retrospective analysis of CT images and medical notes were used for data analysis.The CT scans of all 23 patients showed evidence of involvement of disease outside the external auditory canal, conWrming the diagnosis. Sixteen out of 23 patients (70%) demonstrated evidence of bone erosion. Four of the 16 showed involvement of the petrous apex. From our subset of ten patients with cranial nerve involvement, eight demonstrated evidence of bone erosion and two showed mastoid and middle ear involvement without bone erosion. All four patients with petrous apical involvement presented with cranial nerve palsies (two lower cranial nerve palsies, one seventh nerve palsy and one combined lower and seventh nerve palsy). CT scanning was found to be a fast and economical tool in the initial assessment of patients with malignant external otitis. Petrous apex involvement was constantly associated with cranial nerve palsies, usually the lower cranial nerves. CT Wndings of temporal bone in itself however, were not closely correlated to the clinical outcome of the patients.
Temporal bone osteomyelitis and temporoparietal abscess secondary to malignant otitis externa
Journal of Laryngology and Otology, 2009
We report an advanced presentation of osteomyelitis of the temporal bone secondary to malignant otitis externa. We present a case report and a review of the world literature concerning osteomyelitis of the temporal bone secondary to malignant otitis externa. A 60-year-old diabetic man developed osteomyelitis of the temporal bone and a temporoparietal abscess as advanced complications of malignant otitis externa. He was successfully treated in our institution using a post aural incision after draining the abscess and excising the fistula, a modified radical mastoidectomy with canal wall down procedure with sequesterectomy and debridement of surrounding area done. The terms 'osteomyelitis of the temporal bone', 'skull base osteomyelitis' and 'malignant otitis externa' have not been clearly defined, and have in the past often been used interchangeably in the literature. Osteomyelitis of the temporal bone can occur secondary to malignant otitis externa, acute otitis media, chronic suppurative otitis media or trauma. Here, we present the management of an advanced case of osteomyelitis of the temporal bone.
From Uncommon Infection to Multi-Cranial Palsy: Malignant External Otitis Insights
Dose-Response, 2020
Purpose: The progression of the otitic infectious process toward diseases of particular severity is often unpredictable, just as it is challenging to manage the patient over time, even after the apparent resolution of the disease. We aim to define a radiological reading key that allows us to correctly and promptly treat the disease, avoiding the possible severe complications. Methods: We conducted a retrospective study of 13 cases of basal cranial osteomyelitis (SBO) due to malignant external otitis, by the ENT Department of the University of Catania. Through a standardized approach and following the latest guidelines, we have evaluated all patients performing a standardized and personalized radiological protocol according to the stage of the patient’s pathology and modulating the treatment consequently. Results: Clinical signs have been observed such as otorrhea (100%), otalgia in 13/13 patients (100%), granulations in external auditory canal (100%), preauricular cellulitis in 9/13...
Preliminary results on scintigraphic evaluation of malignant external otitis
European Journal of Nuclear Medicine, 1993
fatal otitis occurring in diabetic and immunosuppressed patients, which may cause cranial nerve palsies and massive thrombophlebitis of the brain. We studied five diabetic patients with the clinical diagnosis of external otitis who were suspected of having MEO and one diabetic patient presumed cured from MEO. All of them underwent methylene diphosphonate, nanocolloid and gallium single-photon emission tomography studies with quantitative analysis on the basis of regions of interest and count profile curves. This combined assessment helped us to diagnose and follow-up soft tissue and temporal bone infection, especially in the case of transsphenoidal extension of the disease, since conventional radiology and computed tomography were of no particular help. On the basis of these results, we consider scintigraphic demonstration of skull base infection as a fourth criterion of MEO given that the classical Chandler's triad (diabetes, granulorna, and Pseudomonas aeruginosa) is not always present.
European Journal of General Medicine, 2011
Aim: Computerized tomography (CT) examination of temporal bone is a routine procedure in the diseases of the middle ear. The aim of this study is to establish the efficacy of CT in the diagnosis of the complications due to inflammatory pathologies of middle ear. Method: Patients with suspected middle ear pathology were undergone temporal CT examination between August 2006-June 2008. 56 patients who underwent operation with various complications due to chronic otitis media and choleostatoma were included in the study group. Complications that developed chronic inflammation secondary were established as tympanosclerosis, ossicle erosion, scutum erosion, tegmen erosion, irregularity in mastoid bone cortex and contour of facial nerve, semicircular canal defect and chronic mastoiditis.
Imaging of temporal bone inflammations in children: a pictorial review
Neuroradiology, 2019
Purpose Understanding the underlying pathophysiology and the patterns of disease spread is crucial in accurate image interpretation. In this pictorial review, the common and important inflammatory processes of the temporal bone in children will be discussed, and key computed tomography (CT) and magnetic resonance imaging (MRI) features described. Methods Inflammatory processes are categorized by anatomical location: the petrous apex and the inner, middle and outer ear. A complete review of the literature is provided. Results Cholesteatoma, cholesterol granuloma and mucoceles are inflammatory processes that occur across the anatomical subsites of the temporal bone, whilst site-specific inflammatory processes include labyrinthitis ossificans in the inner ear and keratosis obturans in the external ear. Infection is a key cause of inflammation in the temporal bone, and specific infections include petrous apicitis, otitis media and necrotizing otitis externa. Finally, important mimics and do-not-touch lesions are considered. CT and MRI are complementary in assessing these disorders, as two of the most important diagnostic clues are the presence of bone erosion, best appreciated on CT, and true diffusion restriction as seen on MRI. Flow charts to assist in the diagnosis of paediatric temporal bone inflammatory disease are also provided. Key Points Inflammation and infection of the temporal bone in children are common and can have a high morbidity and mortality if unrecognised. Computed tomography and magnetic resonance imaging are complementary in the diagnosis of inflammatory temporal bone disease in children. Analysing for the presence of and pattern of bone erosion is often a key diagnostic feature in these conditions.